Prediction of postoperative hematoma occurrence after ultrasound-guided vacuum-assisted breast biopsy in minimally invasive surgery for percutaneous removal of benign breast lesions.

BACKGROUND: The exact factors and mechanisms involved in the development of hematoma after breast ultrasound (US)-guided vacuum-assisted biopsy (VAB) are not clear. This study aimed to analyze the occurrence, prognosis, and risk factors of hematoma after US-guided VAB for the removal of benign breast lesions. METHODS: This was a retrospective study of consecutive female patients with breast lesions (BI-RADS 3/4a/4b and confirmed as benign by core needle biopsy) removed by percutaneous excisional biopsy by US-guided VAB at the Beijing Chaoyang Hospital from April 2016 to December 2018. Univariable analyses were conducted to identify the factors associated with hematoma (age, nodule size, laterality, nodule location, number of nodules, BI-RADS classification of ultrasound, pathology, breast shape, menstrual period, efficacy time of bandage, and hemostatic agents). Multivariable analysis was performed to identify the factors independently associated with hematoma. RESULTS: A total of 293 patients (343 breast lesions) were included. Lesion removal was successful in all cases. Hematomas ≥1 cm were found in 39 patients. Finally, 38 (97.4%) hematomas were absorbed completely within 6 months. The multivariable logistic regression analysis revealed that lesion size (P<0.001; OR: 5.775; 95% CI: 2.752-12.121), number of lesions (P=0.011; OR: 3.205, 95% CI: 1.311-7.834), and the efficacy time of bandage 12-24 h (P=0.003; OR: 5.257, 95% CI: 1.792-15.421) were independently associated with hematoma occurrence after US-guided VAB excision of breast lesions. A lesion size cut-off of 23.4 mm (AUC 0.764, 95% CI: 0.692-0.837; 59.0% sensitivity; 80.3% specificity; 77.5% accuracy; P<0.001) could predict hematoma occurrence. CONCLUSIONS: US-guided excisional VAB can effectively remove benign breast lesions. The factors independently associated with postoperative hematoma are lesion size, lesion number, and effective postoperative compression time of bandage.